Ebraheim N A, Mekhail A O
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
J Orthop Trauma. 1997 Apr;11(3):195-9. doi: 10.1097/00005131-199704000-00010.
To describe the course of the infrapatellar branch of saphenous nerve (IPBSN) and define a risk zone in which the nerve would probably be located.
The course of the IPBSN was studied in twenty-eight cadaver specimens (fifteen male and thirteen female) chosen haphazardly. SETTING AND MAIN OUTCOME MEASUREMENTS: The adductor tubercle and the junction between the inferior pole of the patella and the medial (point A) and lateral (point B) borders of the patellar tendon were taken as reference points. The level of the joint line as well as the point of crossing of the IPBSN at the joint line were measured in relation to point A.
The IPBSN was located at 7.7 +/- 16.8 mm posterior to the adductor tubercle at the level of point A; at 0.8 +/- 20.5 mm anterior to the adductor tubercle at the level of joint line; and at 12.1 +/- 18.8 mm anterior to the adductor tubercle at 30 degrees from point A. The IPBSN crossed to the lateral border of the patellar tendon in 10 of the 28 specimens (36%). The vertical distance between point B and the nerve was 37.8 +/- 23.5 mm. Three zones are defined in relation to point A: a safe zone, a gray zone, and a risk zone. The limits of the safe zone could be represented by a curved line that crosses the following points: 31.0 mm medial to point A and at the same level; 17.2 mm from point A at the joint line; 13.2 mm infromedial to point A at an angle of 30 degrees; 9.6 mm at an angle of 60 degrees; and 5.8 mm inferior to point A.
Avoiding the risk zone in which the nerve would probably be located and performing a blind puncture or an arthrotomy within the safety zone may decrease the incidence of IPBSN injury.
描述隐神经髌下支（IPBSN）的走行，并确定该神经可能所在的危险区域。
对随机选取的28具尸体标本（15例男性和13例女性）进行IPBSN走行的研究。
以内收肌结节以及髌骨下极与髌腱内侧（A点）和外侧（B点）边界的交点作为参考点。测量关节线水平以及IPBSN在关节线处的交叉点相对于A点的位置。
在A点水平，IPBSN位于内收肌结节后方7.7±16.8mm处；在关节线水平，位于内收肌结节前方0.8±20.5mm处；在与A点呈30度角处，位于内收肌结节前方12.1±18.8mm处。在28例标本中有10例（36%）IPBSN越过髌腱外侧缘。B点与神经之间的垂直距离为37.8±23.5mm。相对于A点定义了三个区域：安全区、灰色区和危险区。安全区的边界可用一条曲线表示，该曲线经过以下各点：A点内侧31.0mm且处于同一水平；关节线处距A点17.2mm；与A点呈30度角时位于A点内前方13.2mm处；呈60度角时为9.6mm；以及A点下方5.8mm处。
避开神经可能所在的危险区域，并在安全区内进行盲穿或关节切开术，可能会降低IPBSN损伤的发生率。
